Patient Information Forms

In order to save time when you visit our office for an appointment, please click the printable forms now available on our website.

Please remember to sign and bring this form with you together with your insurance cards, x-rays or medical records when you come to the office for your first visit.

NOTE: The links with this symbol are Adobe Acrobat PDF documents. To view and print them you must have the free Acrobat reader installed on your system. You can download the most recent version of Acrobat Reader here.

• Patient Registration Form
• General Health Questionnaire Form
• HIPAA Privacy Notice
• Arbitration Agreement
• Patient Record of Disclosures
• Records Release From ENT
• Records Release To ENT
• Dr. John E. Butler's Patient Education
  • Ventilating Ear Tubes
  • Tonsillectomy / Adenoidectomy
  • Habituation Excercises
  • Acid Reflux (heartburn)
  • Nosebleeds - Prevention & Treatment
  • Nasal Irrigation